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Argilés Huguet, Josep Ma.

Busquets Rius, Sílvia

López-Soriano, Francisco J.

Diposit Digital de la Universitat de Barcelona

SpecimenThis is a specimen version. For full access to the document please             contact: idea@fbg.ub.eduCopyright  © 2011  University of BarcelonaAuthors: Josep M. Argilés, Francisco J. López-Soriano and Silvia Busquets             ????????????EXIA SCORECA?????????CO QUESTIONNAIRE(Un        (Under  Validation Edition)Page 1 of 6SpecimenCopyright  © 2011  University of BarcelonaAuthors: Josep M. Argilés, Francisco J. López-Soriano and Silvia BusquetsCACHEXIA SCORE???????????????CASCO QUESTIONNAIRE(Under Validation Edition)Page 2 of 6tCASCO Questionnaire©All rights reserved.No part of this document covered by copyrights may be reproduced or transmitted in any form or by any meanswithout prior permission of the copyright holder.The CASCO Questionnaire and the modules wich supplement it, are copyrighted and may not be used without priorwritten consent of the University of Barcelona.Requests for permission to use the CASCO questionnaire and the modules, or to reproduce or quote materialscontained in this document should be addressed to:Fundació Bosch i GimperaArea de Valorització i Llicències.Baldiri Reixac, 4-6, Torre D, 3ª  Planta08028 BarcelonaSPAINTel: +34 93 403 9970Fax: +34 93 403 9767Email: idea@fbg.ub.eduAttentionThe CASCO Questionnaire is a tool currently under validation process. Nowarranty is provided regarding the content and calculations included.Only use for scientific review is permitted.Clinical use of the CASCO Questionnaire is not allowed.                       Copyright © 2011. University of Barcelona.                      Under validation edition, 2011SpecimenThis is a specimen version. Full access to the document is available atCopyright  © 2011  University of BarcelonaAuthors: Josep M. Argilés, Francisco J. López-Soriano and Silvia BusquetsCACHEXIA SCORECASCO QUESTIONNAIRE(Under Validation Edition)Page 3 of 6http://www.fbg.ub.edu/index.php?option=com_content&task=view&id=251&Itemid=Patient CodeCountrySite NumberPatient's InitialsBirthdateDateUnderlying diseaseTreatment(Drugs, nutrition, Others)CACHEXIA SCORE Classified asBWC IMD PHP ANO QoLIndex of cachexia< 5%> or equal to 5%, mild> or equal to 10%, moderate> or equal to 15%, severe> or equal to 20%, terminalNo change in LBMLoss of LBM > 10%MethodologyInitial weightFinal weight% Weigt loss5 mg/l ? CRP ? 10 mg/l10 mg/l < CRP ? 20 mg/lCRP > 20 mg/lNot TestedCalculated ValuesBODY WEIGHT LOSS AND COMPOSITION (BWC)INFLAMMATION / METABOLIC DISTURBANCES / IMMUNOSUPPRESSION (IMD)4 pg/ml ? IL6 ? 10 pg/ml10 pg/ml ? IL6 ? 30 pg/mlIL6 > 30 pg/mlNot TestedPlasma Albumin < 3.2 g/dLPlasma Pre-Albumin < 1.6 mg/dLPlasma Lactate > 2.2 mMPlasma Triglycerides > 200 mg/dLAnemia: Hb < 12 g/dLPlasma Urea > 50 mg/dLROS plasma levels > 300 FORT UGlucose Tolerance test / HOMA index alteredINFLAMMATIONMETABOLICDISTURBANCES*IMMUNOSUPPRESSION* Absolute values of lymphocytesBody Weight Loss Lean Body MassPlasma CRP Plasma IL6* not tested parameters should be left blank* not tested parameters should be left blankBefore applying CASCO, what is your perception of severity of patient’s cachexiaaccording to the following scale (normal, absence of cachexia) 0 1 2 3 4 5 6 7 8 9 10(terminal, evident cachexia)S  by EmailP FormS	 . 0 .  . S	0000 0 00R FormSpecimenhCopyright  © 2011  University of BarcelonaAuthors: Josep M. Argilés, Francisco J. López-Soriano and Silvia BusquetsCACHEXIA SCORECASCO QUESTIONNAIRE(Under Validation Edition)Page 4 of 6tWe are interested in knowing some information related to your health status. Please provide an answer all the questionsbelow. There are no "right" or "wrong" answers. The information provided will remain strictly confidential.PHYSICAL PERFORMANCE (PHP)[1]Not at all A little Quite a bit Very MuchHave you noticed any particular decrease in the physicalactivities (i.e. at work, at home, at leisure etc) that younormally carry out during the day?Have you had any problem doing strenuous activities, likecarrying a heavy shopping bag or a suitcase?1.2.Have you noticed any loss of handgrip force?3.Did you have to put more effort on climbing stairs?4.Have you felt tired after walking approximately half akilometre?5.ANOREXIA (ANO) [2]My appetite is:1.Very poorPoorAverageGoodVery good I hardly ever feel fullI feel full after eating most of the mealI feel full after eating over half a mealI feel full after eating about a third of a mealI feel full after eating only a few mouthfulsVery goodGoodAverageBadVery badone meal a daytwo meals a daythree meals a daymore than three meals a dayless than one meal a dayFood tastes:3.When I eat:2.Normally I eat:4.Birthdate DatePatient's InitialsDuring the past week:Please go to the last page of the questionnaire to perform MONITORING TEST of the Physical Perfomance[2] Questions from 1-4 extracted from SNAQ of St. Louis GRECC Program of St. Louis VA Medical Center. Used with permission.[1] Question 2 copyright of 1995 EORTC Quality of Life Group. Extracted from QLQ-C30 and used with permission.SpecimenTCopyright  © 2011  University of BarcelonaAuthors: Josep M. Argilés, Francisco J. López-Soriano and Silvia BusquetsCACHEXIA SCORECASCO QUESTIONNAIRE(Under Validation Edition)Page 5 of 6hQUALITY OF LIFE (QoL)Very MuchQuite a bitA littleNot at allDo you need to stay in bed or a chair during the day?Do you need help with eating, dressing, washing yourself or using the toilet?1.2.Were you limited in doing either your work or other daily activities?3.Were you limited in pursuing your hobbies or other leisure time activities?4.Were you short of breath?5.Excellent Fine Poor Very PoorHave you had pain?6.Did you need to rest?7.Have you had trouble sleeping?8.Have you felt weak?9.Have you felt nauseated?10.Have you vomited?11.Have you been constipated?12.Have you had diarrhea?13.Did pain interfere with your daily activities?14.Have you had difficulty in concentrating on things, like reading anewspaper or watching television ?15.Did you feel tense?16.Did you worry?17.Did you feel irritable?18.Did you feel depressed?19.Have you had difficulty remembering things?20.Have your physical condition or medical treatment interefered with yourfamily life?21.Have your physical condition or medical treatment interefered with yoursocial activities?22.Have your physical condition or medical treatment caused you financialdifficulties?23.How do you rate your overall health during the past week?24.How do you rate your overall quality of life during the past week?25.DatePatient's Initials BirthdateDuring the past week:Questions 1-25 copyright of 1995 EORTC Quality of Life Group. Extracted from QLQ-C30 and used with permission.SpecimenTCopyright  © 2011  University of BarcelonaAuthors: Josep M. Argilés, Francisco J. López-Soriano and Silvia BusquetsCACHEXIA SCORECASCO QUESTIONNAIRE(Under Validation Edition)Page 6 of 6hPHYSICAL PERFORMANCE (PHP) (Cont.)MonitoringMonitoring will take place at the same moment as the questionnaire is filled, normally at the time of diagnose.If monitoring is NOT available the questionnaire will always be used. The very first calculation of theCACHEXIA SCORE will use the values from the questionnaire. Subsequent calculations will use themonitored values according to the following scale:1. Total Activity:ValueCurrent Test DateValueCurrent Test Date2. Handgrip strength:ValueCurrent Test Date3. Stairs climb:4. 6-min walk distance:ValueCurrent Test DateBirthdatePatient's InitialsValuePrevious Test DateValuePrevious Test DateValuePrevious Test DateValuePrevious Test DateReduction of Total Activityfrom previous measurement in %Reduction of Handgrip Strengthfrom previous measurement in %Reduction of Stairs Climbfrom previous measurement in %Reduction of 6-min Walkfrom previous measurement in %0000

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